Can an apple a day keep the doctor away? Probably not; however, staying away from the doctor’s office can feel like a money-saving measure. But did you know that you’re legally entitled to a number of free health screenings and vaccinations each year?
Under the Affordable Care Act, most insurance policies, including Medicaid and Medicare, are required to offer certain preventive healthcare services at no cost to you — with a couple of disclaimers, which we’ll discuss below.
If you don’t have insurance coverage, many services are still available for free or at heavily discounted rates through community clinics, local nonprofit organizations and other places. As we enter a new year, here are several types of doctor’s appointments that are typically fully covered.
What’s a preventive service and why do we need them?
Chronic conditions, many of which are preventable, cost the US hundreds of billions of dollars a year. Almost 6 in 10 Americans today live with at least one chronic health condition and nearly 30 percent struggle with three or more, according to 2017 research from the nonprofit RAND Corporation.
Preventive screenings can improve overall health, identify acute diseases, prevent or detect cancer at earlier stages and help patients address conditions like obesity or high cholesterol sooner rather than later.
“Early detection and prevention through regular check-ups can save you a lot of money and discomfort down the road,” says Dr. Amy Faith Ho, a Dallas-based emergency medicine physician. “Treating a medical problem is both onerous and expensive, but preventing a medical issue before it becomes a problem is often simple and free.”
In fact, the Patient Protection and Affordable Care Act (ACA) requires private insurance providers to offer access to preventive services. These services must be offered without cost-sharing, which means your insurance company cannot charge you a coinsurance or copay.
These services include:
- Preventive services with an “A” or “B” grade rating by the US Preventive Services Task Force (USPSTF)
- Routine vaccines for adults and children recommended by the Advisory Committee on Immunization Practices (ACIP)
- Preventive services for infants, children and teens recommended by the Health Resources and Services Administration (HRSA)
- Women-specific care and screenings recommended by the HRSA
Let’s break these preventative screenings down…
Your annual physical
These are some standard preventive screenings and health metrics that you and your primary care provider should track on a regular basis. Your doctor will typically go over these benchmarks, including by taking various blood pressure and cholesterol levels, in an annual physical.
Depending on your health habits and family health history, your PCP may order some additional tests or screenings, such as a colonoscopy if you’re at high risk for colon cancer, which may be covered as preventive care. If your results come back clean, you will likely be asked to repeat the exam at a later date, which should also be covered under preventive care.
If you don’t have a PCP or can’t get a timely appointment with your usual doctor, you may be able to reach out to your regional clinic or community health center, which may be able to accommodate you more quickly. As always, be sure to confirm that the facility you visit is in-network with your insurance provider to avoid paying for your visit out of pocket. Physicals can range anywhere from $100 to $300 out of pocket.
Ob-gyn checkups
People with uteruses are eligible for annual wellness checks under the ACA. Most health insurance plans will cover one visit each year, and uninsured people can often access care through Planned Parenthood or local community health centers at no or reduced cost.
Here’s what you can expect at a visit with an ob-gyn.
Pregnancy treatment
Private health insurance and Medicaid cover preventive services for pregnant people. (More than 40 percent of pregnant people in the US are covered by Medicaid, according to Planned Parenthood.)
If you’re pregnant, these appointments are typically covered:
- Hepatitis B screening for all pregnant people at the first prenatal visit
- Gonorrhea screening for higher-risk patients
- Gestational diabetes screening at 24 weeks or later, or earlier for high-risk patients
- Rh incompatibility screening
- Preeclampsia prevention and screening for patients with high blood pressure
- Breastfeeding support and counseling
- Maternal depression screening at well-baby visits
- Expanded tobacco intervention and counseling for pregnant tobacco users
- Urinary tract or other infection screening
Well-baby and well-child visits
Finding a trustworthy pediatrician who is in your insurance network is incredibly important, since babies and children need so much attention across many areas of development and growth. Most insurance plans will cover preventive screenings and checkups offered by health care professionals within your network.
If you don’t have private health insurance, your child may be eligible for coverage under the Child Health Insurance Programs (CHIP) through both Medicaid and separate CHIP plans.
Infants need six “well-baby” visits during the first 11 months of life, according to the US Department of Health and Human Services. During these visits, your pediatrician will check standard metrics such as physical height and weight, overall health and reflexes, and developmental milestones.
Free preventive care for older children includes standard wellness check-ins, as well as behavioral assessments and vision and hearing screenings, with additional testing as needed for children with high risk of obesity, lead exposure or oral health issues. Vaccinations are also covered under preventive care guidelines for common diseases such as chicken pox, flu, measles, mumps and rubella (MMR) and diphtheria, tetanus and pertussis (DTaP).
Note that children often get sick or injured and require doctor visits for reasons beyond preventive visits. If you schedule a wellness check-in at the same time as an appointment for a fever, you may still be billed for the illness portion of the visit, even if the check-up is covered under preventive care (more on this below).
Sexually transmitted infection testing
Sexually active adults and teens should regularly screen for common sexually transmitted infections, especially since many can develop without any noticeable symptoms.
Unfortunately, insurance coverage varies widely when it comes to STI testing, since there are a number of preventive service exclusions. Under the ACA, testing for the following STIs is covered for the following demographics without requiring a copay or deductible:
| Women | Men | Adolescents | |
| Chlamydia | Yes, if sexually active and ages 24 and under, (including pregnant women) or sexually active women over 24 who are at increased risk for infection | No | All adolescents between ages 11 and 21, including annual screening for all sexually active girls and young women, as well as sexually active boys and young men who are at increased risk for infection (e.g., men who have sex with men) |
| Syphilis | Yes, if sexually active and at increased risk of infection; screen all pregnant women | Yes, if sexually active and at increased risk of infection | Sexually active adolescents between the ages 11 and 21 who are at increased risk for infection |
| Gonorrhea | Yes, if sexually active and ages 24 and under, (including pregnant women) or sexually active women over 24 who are at increased risk for infection | No | All adolescents between ages 11 and 21, including annual screening for all sexually active girls and young women, as well as sexually active boys and young men who are at increased risk for infection (e.g., men who have sex with men) |
| Cervical cancer | Average-risk women aged 21 to 65 years should be screened for cervical cancer. Ages 21 to 29: cervical cytology (Pap test) every three yearsAges 30 to 65: cervical cytology (Pap test) every three years OR every five years with high-risk human papillomavirus testing (hrHPV) OR every 5 years with hrHPV testing in combination with cytology testing (co-testing) |
No | No |
| HPV vaccination | After age 15 or for people with certain immunocompromising conditions, the recommended immunization schedule is three doses of HPV vaccine. | After age 15 or for people with certain immunocompromising conditions, the recommended immunization schedule is three doses of HPV vaccine. | Routinely recommended at age 11 or 12; if given before age 15, the recommended immunization schedule is two doses of HPV vaccine. |
There are many STIs that aren’t on this list but which can still endanger your health or that of other people.
If you are sexually active, it’s a good idea to get tested on a regular basis regardless of cost, especially if you have more than one sexual partner. Your local community health center or any Planned Parenthood facility can help you schedule a test. Each test panel can cost up to $250 out of pocket, although health insurance can reduce the cost in many cases, while other facilities may offer discounted or free testing based on financial need.
COVID-19 vaccines
COVID-19 vaccines are free for anyone living in the US, regardless of immigration or health insurance status, and can be administered to most people six months or older.
Additional vaccines
Many vaccines for common diseases are free or offered at reduced cost for most adults and children, including those on Medicare and Medicaid. Dosages, recommended ages and populations vary based on the illness.
The fine print
When scheduling your preventive care appointments, keep these two crucial details in mind to avoid getting an unexpected bill in the mail.
Make sure you see a doctor within your insurance network
Preventive services under private insurance are only free when you see a healthcare provider who is in-network with your insurance company. If the doctor you see isn’t on your carrier’s list of approved medical professionals, your insurance provider isn’t obligated to cover your visit. You can find an in-network doctor through Zocdoc.
At the beginning of the year, it’s a good idea to check with your healthcare providers to ensure they all have your latest insurance paperwork and that none of them have left or changed the terms of their agreement with your network.
Don’t tack on other issues during a preventive visit
Keep in mind that ACA-covered preventive services are only free for preventive issues, which include health concerns that haven’t been diagnosed yet. It may make logical sense to discuss all of your ailments during your preventive wellness check. But if you do so, your doctor could technically bill your insurance for a standard office visit.
What should you do instead? Before you get too detailed with listing your ailments, double-check with your doctor to make sure that you’re discussing information that still qualifies under preventive care.
If you want to discuss an issue that falls outside of the realm of a wellness exam, schedule a follow-up appointment to do so at another time. Alternatively, you can take care of any and all business during a single appointment — just know that visit may not qualify for free coverage under your insurance plan.